Intraoperative Incidents and Complications in Primary Arthroscopic Anterior Cruciate Ligament Reconstruction

Arturo Almazán, Antonio Miguel, Alberto M Odor, José Clemente Ibarra

Research output: Contribution to journalArticlepeer-review

45 Scopus citations


Purpose: To analyze intraoperative incidents and complications in primary arthroscopic anterior cruciate ligament reconstruction (ACLR) with bone-patellar tendon-bone (BPTB) and quadruple hamstring semitendinosus and gracilis (STG) grafts. Methods: From January 1999 to June 2004, we performed 330 BPTB and 96 STG procedures. Intraoperative incidents and complications were recorded for each case. Results: Our overall intraoperative incident and complication rate was 9.6% and was higher in the STG group (13.5%) than in the BPTB group (8.7%). In the BPTB group, combined incidents and complications according to stage of the procedure consisted of graft harvesting, 4 cases (1.21%); tunnel placement, 9 cases (2.7%); and graft fixation, 15 cases (4.5%). In the STG group, combined incidents and complications included graft harvesting, 8 cases (8.3%); tunnel placement, 1 case (1%); graft fixation, 3 cases (3.1%); and others, 1 case (1%). In 4 patients (0.9%), we had to change the technique from BPTB to STG and vice versa. In 2 STG cases, conversion of the technique was required because of graft-related problems; in the third case, it was necessary because of fixation. One BPTB was converted to STG because the graft was completely transected as a result of improper screw fixation technique. Conclusions: None of the encountered incidents and complications had an adverse effect on final stability or on range of motion in operated knees. All incidents and complications were due to technical errors that occurred during graft harvesting, tunnel placement, or graft fixation. It is known that technical errors are preventable if careful surgical technique is followed. The surgeon must be well versed in various reconstruction techniques to be able to detect and resolve forthcoming incidents or complications. Backup implants are mandatory. Level of Evidence: IV, therapeutic case series.

Original languageEnglish (US)
Pages (from-to)1211-1217
Number of pages7
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
Issue number11
StatePublished - Nov 2006
Externally publishedYes


  • ACL reconstruction
  • Complications
  • Incidents
  • Intraoperative

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery


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